Öz
Retroperitoneal bölgenin enfeksiyonları belirsiz sinsi semptomlar ve nonspesifik klinik bulgu ve
semptomlar nedeniyle tanı konulması zordur. Retroperitoneal abse acil serviste nadiren karşılaşılan
potansiyel olarak hayatı tehdit edici intra-abdominal enfeksiyondur. Etyolojik olarak primer ve sekonder
olarak ikiye ayrılır. En yaygın nedenleri üriner sistem enfeksiyonları, gastrointestinal sisteme ait hastalıklar,
vertebra ve böbrek tüberkülozudur. Daha az görülen nedenleri arasında kemik enfeksiyonları, travma, uzak
enfeksiyonlardan hematojen yolla yayılım ve kanser hastalıklarını içerir. Biz burada 51 yaşında mental
retardasyonlu, başka ek hastalığı bulunmayan, tanı konulamamış ve etiyolojisi belirlenemeyen dev bir
retroperitonel abseli hastayı tartıştık. Sonuç olarak bu tür hastaların zamanında tanı ve tedavisi için yüksek
şüphe endeksi gereklidir özellikle mental retardasyon da bulunuyorsa.
Anahtar Kelimeler
Retroperitoneal Abse Batın bigisayarlı tomografisi AcilServis
Kaynakça
- 1.Ohara G, Kondo T, Kagohashi K, Watanabe H, Kawaguchi M, Kurishima K, et al.Retroperitoneal abscess shortly after chemotherapy for lung cancer: A case report.MolClinOncol. 2014 ;2(2):302-4
- 2.Huang SH, Lo WO, Lin CM, Hsieh TS, Wang SF, Tsai SW, Chen KC. Retroperitoneal abscess: 7-year experience of 29 cases in a tertiary care center in Taiwan. J Urol.2015; 26(3):218–21
- 3.Su CN, Hsieh DS, Sun GH, Yu DS, Fong CJ.Primary retroperitoneal abscess complicated with septic arthritis of the hip.J Chin Med Assoc. 2006;69(1):51-3.
- 4.Ioannidis O, Kakoutis E, Katsifa H, Rafail S, Chatzopoulos S, Kotronis Aet al.Streptococcus mutans: a rare cause of retroperitoneal abscess.Adv Med Sci. 2011;56(1):113-8.
- 5.Woo MY.Psoas abscess.J EmergMed. 2014;47(5):129- 30.
- 6.Li SY, Jiang JK, Chang YH, Wu TC, Yang WC, Ng YY.Recurrent retroperitoneal abscess due to perforated colonic diverticulitis in a patient with polycystic kidney disease.J Chin Med Assoc. 2009;72(3):153-5.
- 7.Shigemura K, Arakawa S, Miura T,Yasufuku T, Nakano Y, Tanaka K et al.Retroperitoneal abscess perforating into the thoracic cavity in an immunocompromised host.J Infect Chemother. 2008 ;14(4):305-7.
- 8.Amitai A, Sinert R.Necrotizing fasciitis as the clinical presentation of a retroperitoneal abscessJ Emerg Med. 2008 ;34(1):37-40.
- 9.Russo G, Lichtner M, Carnevalini M, Mascellino MT, Mengoni F, Oliva A et al.Primary retroperitoneal abscesses due to Rhodococcusequi in a patient with severe nephrotic syndrome: successful antibiotic treatment with linezolid and tigecycline.IntJ Infect Dis. 2010 ;14(6):533-5.
- 10.Nguyen CT, Tomford JW, Desai MM. Retroperitoneal cold abscess caused by mycobacteria chelonaeabscessus after percutaneous nephrolithotomy in India: strategies for detection, management, and prevention in the United States.Urology. 2009 ;73(1):209-13.
- 11.Katsuno S, Ando H, Seo T, Shinohara T, Ochiai K, Ohta M. A case of retroperitoneal abscess caused by Salmonella Oranienburg. J Pediatr Surg. 2003 ;38(11):1693-5.
Öz
Retroperitoneal abscess (RA) is an unusual but potentially life-threatening intra abdominal infections which
is rarely encountered in emergency departments (ED) (1,2). Insidious clinical manifestations and occult
nature of abscess make it diagnostic challenge and causes delays and missed diagnosis that leads to
prolonged sepsis, and increased morbidity and mortality rates (3,4). Retroperitoneal abscess may be
classified as primary if the infection results from hematogenous spread or secondary if they are related to an
infection in an adjacent organ. In a small percent RA may be idiopathic (4,5) which infections may be
monomicrobial but are in most cases polymicrobial (4). Most commonly origin of abscess is primarily
urinary tract infection, followed in frequency bowel-related diseases such as diverticulitis (1,6),
retroperitoneal appendicitis, pancreatitis, biliary, and peptic ulcer diseases spinal and renal tuberculous
disease(3). But cases have been described resulting from bone infections, trauma, hematogenous spread and
malignancies(2,4). The most commonly isolated pathogens are gram-negative bacilli such as Escherichia
coli and Proteus mirabilis in frequency, but anaerobic species such as Bacteroides may also be found Grampositive
cocci, mainly staphylococcal species and rarely streptococcal species, are usually isolated in cases
of hematogenous spread(4). Manifest clinical symptoms include fever, abdominal and/or flank pain, lumbar
mass, weakness, weight loss and anorexia (4). Mainly predisposing factors are diabetes mellitus and
immunocompromised hosts (7). The most reliable and sensitive diagnosis tool remains Computed
tomography CT scan (4,8). The treatment modalities consist of open surgery, percutaneous drainage and
accompanied intravenous antibiotic administration (1,4).
We reported here a case of RA secondary to unknown etiology in a patient with mentally retarded, whose
specification was delayed for weeks before it diagnosed and reached huge size.
Anahtar Kelimeler
Retroperitoneal Abscess Abdominal computed tomography Emergency Department
Kaynakça
- 1.Ohara G, Kondo T, Kagohashi K, Watanabe H, Kawaguchi M, Kurishima K, et al.Retroperitoneal abscess shortly after chemotherapy for lung cancer: A case report.MolClinOncol. 2014 ;2(2):302-4
- 2.Huang SH, Lo WO, Lin CM, Hsieh TS, Wang SF, Tsai SW, Chen KC. Retroperitoneal abscess: 7-year experience of 29 cases in a tertiary care center in Taiwan. J Urol.2015; 26(3):218–21
- 3.Su CN, Hsieh DS, Sun GH, Yu DS, Fong CJ.Primary retroperitoneal abscess complicated with septic arthritis of the hip.J Chin Med Assoc. 2006;69(1):51-3.
- 4.Ioannidis O, Kakoutis E, Katsifa H, Rafail S, Chatzopoulos S, Kotronis Aet al.Streptococcus mutans: a rare cause of retroperitoneal abscess.Adv Med Sci. 2011;56(1):113-8.
- 5.Woo MY.Psoas abscess.J EmergMed. 2014;47(5):129- 30.
- 6.Li SY, Jiang JK, Chang YH, Wu TC, Yang WC, Ng YY.Recurrent retroperitoneal abscess due to perforated colonic diverticulitis in a patient with polycystic kidney disease.J Chin Med Assoc. 2009;72(3):153-5.
- 7.Shigemura K, Arakawa S, Miura T,Yasufuku T, Nakano Y, Tanaka K et al.Retroperitoneal abscess perforating into the thoracic cavity in an immunocompromised host.J Infect Chemother. 2008 ;14(4):305-7.
- 8.Amitai A, Sinert R.Necrotizing fasciitis as the clinical presentation of a retroperitoneal abscessJ Emerg Med. 2008 ;34(1):37-40.
- 9.Russo G, Lichtner M, Carnevalini M, Mascellino MT, Mengoni F, Oliva A et al.Primary retroperitoneal abscesses due to Rhodococcusequi in a patient with severe nephrotic syndrome: successful antibiotic treatment with linezolid and tigecycline.IntJ Infect Dis. 2010 ;14(6):533-5.
- 10.Nguyen CT, Tomford JW, Desai MM. Retroperitoneal cold abscess caused by mycobacteria chelonaeabscessus after percutaneous nephrolithotomy in India: strategies for detection, management, and prevention in the United States.Urology. 2009 ;73(1):209-13.
- 11.Katsuno S, Ando H, Seo T, Shinohara T, Ochiai K, Ohta M. A case of retroperitoneal abscess caused by Salmonella Oranienburg. J Pediatr Surg. 2003 ;38(11):1693-5.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Olgu Sunumu |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Ağustos 2016 |
| Gönderilme Tarihi | 31 Ocak 2016 |
| Kabul Tarihi | 23 Şubat 2016 |
| Yayımlandığı Sayı | Yıl 2016 Cilt: 13 Sayı: 2 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty